Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France; INSERM, U975, Paris, France; CNRS, UMR 7225, CR-ICM, Paris, France; Neurosurgery Department, APHP, Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Paris, France.
Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France; INSERM, U975, Paris, France; CNRS, UMR 7225, CR-ICM, Paris, France; Neurology Department, APHP, Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Paris, France.
Parkinsonism Relat Disord. 2019 May;62:91-97. doi: 10.1016/j.parkreldis.2019.01.021. Epub 2019 Jan 24.
Freezing of gait (FOG) and falls are the most disabling motor symptoms in Parkinson's disease (PD) patients. The effects of subthalamic deep-brain-stimulation (STN-DBS) on FOG and falls are still a matter of controversy, and factors contributing to their outcome have yet to be defined.
We examined the relationship between FOG and falls after STN-DBS and preoperative clinical features, MRI voxel-based-morphometry (VBM) analysis and statistical mapping of electrode locations.
331 patients (age at surgery = 57.7 ± 8.4 years; disease duration = 12.5 ± 5 years) were included in the final analysis, with VBM analysis in 151 patients. After surgery, FOG was aggravated in 93 patients and falls in 75 patients. After surgery, FOG severity was related to its level before surgery without dopaminergic treatment, the dopaminergic treatment dosage and severity of motor fluctuations after surgery; and falls severity to lower postoperative cognitive performance. VBM analyses revealed that, relative to other patient groups, patients with FOG worsening had putamen grey matter density decrease, and fallers patients a left postcentral gyrus atrophy. The best effects of STN-DBS on FOG and falls were associated with the location of contacts within the STN, but no specific location related to aggravation.
FOG and falls are reduced after STN-DBS in about 1/3 of patients, with the best effects obtained for electrodes located within the STN. Clinicians should be aware that, after STN-DBS, FOG severity is related to preoperative FOG severity whatever its dopa-sensitivity; and falls to lower postoperative cognitive performance; and atrophy of cortico-subcortical brain areas.
冻结步态（FOG）和跌倒都是帕金森病（PD）患者最具致残性的运动症状。丘脑底核（STN）深部脑刺激（DBS）对 FOG 和跌倒的影响仍存在争议，其结果的影响因素尚未确定。
我们研究了 STN-DBS 后 FOG 和跌倒与术前临床特征、磁共振成像基于体素的形态计量学（VBM）分析和电极位置的统计映射之间的关系。
331 例患者（手术时年龄为 57.7±8.4 岁；病程为 12.5±5 年）纳入最终分析，其中 151 例患者进行了 VBM 分析。术后，93 例患者 FOG 加重，75 例患者跌倒。术后 FOG 严重程度与术前未经多巴胺治疗时的 FOG 严重程度、术后多巴胺治疗剂量和运动波动严重程度有关；跌倒严重程度与术后认知功能下降有关。VBM 分析显示，与其他患者组相比，FOG 恶化患者的壳核灰质密度降低，跌倒患者的左中央后回萎缩。STN-DBS 对 FOG 和跌倒的最佳效果与 STN 内接触点的位置有关，但没有与恶化相关的特定位置。
STN-DBS 可使约 1/3的患者 FOG 和跌倒减少，最佳效果出现在位于 STN 内的电极上。临床医生应意识到，STN-DBS 后，FOG 严重程度与术前 FOG 严重程度有关，而与多巴胺敏感性无关；跌倒与术后认知功能下降有关；与皮质下脑区萎缩有关。
